Traumatic brain injury & Treatment

What are the types of traumatic brain injury?

Traumatic brain injury (TBI) can be broadly classified through mechanism of injury:

  1. Direct focal brain damage. This is the physical damage from trauma, such as laceration, haemorrhage (bleeding), fracture and contusion. Surgery may be required to stabilise and control the extent of primary damage.
  2. Diffuse brain damage. This is the secondary damage that occurs following trauma, resulting in brain swelling and diffuse injury to the axons. This can be immediate or delayed, and includes changes in the blood flow to the brain. Blood flow can be increased or decreased through destruction or spasming of the blood vessels, become poorly regulated and as a result decreased oxygenation can lead to cell death.

Brain swelling, in the form of oedema, can also result in other areas of the brain becoming more compromised from pressure within the skull.

What happens after TBI?

Once the direct damage is controlled, medications, positioning and control of the environment assist in reducing the effect of secondary damage while the brain begins to recover.

Depending on the extent of the injury and its location, the following days, months and even years may present with:

  • comatose or abnormal behaviour
  • post-traumatic seizures, headaches and depression
  • hydrocephalus (increased cerebral spinal fluid collected in the cavities of the brain)
  • heterotopic ossification (bone like growth in soft tissue following prolonged bed rest)
  • agitation, anxiety and outbursts of emotion
  • reduced working memory, attention span and ability to make decisions
  • less adaptable thinking
  • insomnia
  • complications with the gut and urinary systems
  • increased muscle tone, spasticity and abnormal postural development
  • changes in vision, taste, touch, speech, swallow and awareness
  • changes in ability to move the body purposefully

How can neurological physiotherapy help?

Neurological physiotherapy can help with the physical side of improving a person’s function. This includes:

  • regaining ability to sit and balance
  • improving arm, trunk and leg control for increased independence
  • improving body awareness and perception
  • reversing the secondary changes associated with deconditioning and bedrest
  • improving weakness, spasticity, and loss of joint and muscle range
  • use of hydrotherapy and guiding to change sensory environment
  • assist in the prescription of suitable gait aids and wheelchairs to improve community reintegration

During the recovery process, neuroplasticity in the form of sensory and motor relearning can happen with skilled decision making, therapeutic handling and activity creation that harnesses the person’s motivational levels. The stronger this desire is, the greater the effect of the relearning tends to be.

Given the unpredictable and often wide ranging effects of TBI, a diverse group of health professionals is often required to best manage the challenges and rehabilitate a person effectively. This includes neurologists, rehabilitation physicians, neuropsychologists, occupational therapists, physiotherapists, orthotics and speech therapists to name a few.

Therapy should be delivered in a context specific, goal and person oriented framework. This is to help empower the person with the TBI to be as independent as possible in their own environment, and ensures their opinions and desires are heard. Therapy should also be flexible to their changing needs, and can occur in bouts of high intensity to make the most of opportunities as they present themselves.

For more information and helpful advice, contact us today!